Neurokin Psychology Service Agreement & Consent
The purpose of this form is to provide information to you about, and to obtain your consent, to engage in psychology services with Neurokin Psychology.This form helps to ensure the welfare, satisfaction, and privacy of our clients. If you have any questions about this service agreement, feel free to email firstname.lastname@example.org.
Neurokin Psychology needs to collect and record personal information from you that is relevant to your situation, such as your name, contact information, medical history and other relevant information as part of providing psychological services to you. This collection of personal information will be a necessary part of the psychological assessment and treatment that is conducted.
The first few therapy sessions will involve a comprehensive evaluation of your needs. As you move through the evaluation, you will be offered some first impressions of what the work will include and a treatment plan to follow. If you have questions about our treatment plan or chosen methodology, you are encouraged to discuss them whenever they arise. You are able to cease assessment and/or therapy with your clinician at any time. If you feel uncomfortable with what is happening in a session you may request for the session to cease at any time, and this will not disadvantage you in subsequent help-seeking efforts.
Purpose of Collecting and Holding Information
Your personal information is gathered as part of your assessment, diagnosis and treatment, is kept securely and, in the interests of your privacy, used only by your psychologist and the authorised personnel of the practice (as necessary). This practice is subject to the Privacy Act 1988 and must comply with obligations related to the collection, use and disclosure of personal information, including through telehealth services.
Your personal information is retained in order to document what happens during sessions and enables the psychologist to provide a relevant, ethical, and informed psychological service to you. To meet Australian privacy legislation all data is stored in Australia and with strict adherence to the Australian Privacy Principles.
During the course of your engagement with Neurokin Psychology, you may be asked to complete online assessment measures hosted by other third party platforms (e.g. WPS Publish, Novopsych, Parinc, and others). These platforms have been selected as they similarly adhere to Privacy Principles, and you can view their respective data security policies via their websites. All clients retain the right to refuse or withdraw consent to provide personal data using these platforms. Raw data and interpretive scores and reports will be saved within your electronic file on our practice management software.
Neurokin Psychology stores personal records electronically in your client file on practice management software Halaxy, which you consent to as a client (or parent/carer/guardian) of this practice. Halaxy has strict data security protocols.
Payments for services can be made via direct deposit (bank transfer), or credit/debit card (via Halaxy). You can view the privacy and data protection policies of Halaxy on-line.
Access to Client Information
As part of providing psychological services, relevant personal information to the current situation will be collected and recorded in Halaxy. Your psychologist is required by law to keep your file for a minimum of 7 years after your last contact with Neurokin Psychology. If you are under the age of 18 at the time of treatment, the information is mandated to be retained until you are 25 years of age. Personal information pertaining to clients who identify as Aboriginal and Torres Straight Islander must be kept permanently. You may access the information in your file on request, subject to the exceptions in the National Privacy Principles. In this instance, you will be encouraged to arrange a session with your psychologist to discuss the content of your file and any foreseeable risks of releasing this personal information. Fees apply for file preparation and review.
Disclosure of Personal Information
All personal information gathered by the psychologist during the provision of the psychological service will remain confidential except when:
it is subpoenaed by a court, or disclosure is otherwise required or authorised by law; or
failure to disclose the information would in the reasonable belief of the psychologist place you or another person at serious risk to life, health or safety; or
your prior approval has been obtained to:
a) provide a written report to another professional or agency. e.g., a GP or a lawyer; or
b) discuss the material with another person, eg. a parent, employer, health provider or third-party funder; or
c) disclose the information in another way
you would reasonably expect your personal information to be disclosed to another professional or agency and disclosure is directly related to the primary purpose for which it was collected such as to inform your GP of treatment and progress; or
consultation with another professional is required to provide better services (identifying details will remain confidential).
If during the course of your work with the psychologist, they become aware of risk to someone’s life, health, or wellbeing, your psychologist is required by policy of the state and federal governments to report the matter to the appropriate agencies.
This practice adheres to a mandatory reporting policy and your psychologist is required by law to report any disclosures of harm, including but not limited to, child sexual assault, physical abuse, or neglect, to the relevant authorities. Your psychologist will notify you if they receive information relating to you that a child under 18 years of age within your care is at risk, and that the psychologist must report such information to the state child protection agency / Police.
Psychologists in Australia are required to engage in continuing professional development, peer consultation, and supervision. At times it may be necessary for your psychologist to discuss your presenting issues, case formulation, assessment results, treatment plan, and/or diagnostic report with their supervisor or peers to ensure ongoing quality assurance. Confidentiality is of utmost importance and all de-identifying details are removed before supervision is sought. The supervisor and professional peers are bound by the same confidentiality rules as your psychologist. As a client of Neurokin Psychology (or parent/carer/guardian), you are consenting to the possibility of your case being reviewed within a supervision capacity.
Abuse/damage to property. We respectfully advise you that any form of disrespectful or threatening behaviour will not be tolerated to any of our staff. Abusive or threatening behaviour (whether in person or via electronic means) will result in services being discontinued.
Assessment information may be utilised for research and service evaluation purposes, but this is only with your consent. All identifying information and names are removed prior to such usage. You have the right to withdraw participation in research at any time, even if you originally gave your consent.
We prefer to send all information and communication electronically, preferably by email and text message (sms). You may remove your consent to receive electronic communication at any time by written notice. Neurokin Psychology does not currently have provisions to send hard copy correspondence by mail.
The APS National Schedule of Recommended Fees 2023/2024 has set the standard consultation fee for a psychologist at $300 for a 50 minute session.
The cost of a standard consultation with the Principal Psychologist at Neurokin Psychology is $250.00 (50 minute session). Your card details will be saved in a secure database (Halaxy) and payment will automatically be processed on the day of your session. You may be eligible for a Medicare rebate ($93.35) with an appropriate Mental Health Care Plan and referral, and this can be processed on your behalf. If you have any problems with Medicare sending you the rebate, you will have to follow up with Services Australia for yourself due to confidentiality limitations. Fees are subject to change and are reviewed each January and July. Please note that our software program charges a small 1.8% card fee for all transactions. You can choose to instead make a bank transfer- please ask us how.
If payment is covered by a third party payer (apart from NDIS), you will be required to pay up front and organise a reimbursement from your funding body after the session. Neurokin Psychology does not bill third parties directly for your consultation.
Any additional correspondence (face-to-face, phone, email) with other professionals, agencies and organisations (at the request of a client) or consultations with the psychologist outside of the organised appointment, will be charged at the standard hourly rate per unit of 15 minutes of correspondence/communication. This includes treatment summary reports, letters of support, and/or request for accommodations for workplaces or educational institutions.
Bulk billing is not offered at this clinic. This clinic does not offer reductions in fees due to having a Health Care Card or Pension- we already have a number of long-term / pre-existing clients whom attract a lower fee to ensure that they can continue to have access to mental health care.
Cancellation fees for therapy clients are as follows:
More than 48 hours (2 business days) notice - Refund provided**
Between 25 and 48 hours (1-2 business days) notice - 50% of consultation fee**
Between 0 to 24 hours (less than 1 business days notice) – No Refund
Please note any changes to Monday appointments must be confirmed by Thursday of the previous week (i.e. 2 business days), and changes to Tuesday appointments must be confirmed by Friday of the previous week. Weekends and public holidays are not counted as business days. Using a secure payment system (via Halaxy), refunds and late cancellation penalties will be automatically processed.
Given the limited availability and extensive wait list for Neurokin Psychology, we reserve the right to terminate your agreement and any remaining consultations if you cancel or re-schedule numerous (e.g. 3) appointments and/or are otherwise experiencing significant difficulties engaging with your proposed treatment plan. The outcomes of therapy are often “dose-dependent”, meaning that your psychologist will help you to understand the importance of the timing, consistency, and frequency of your sessions to make the most meaningful changes. Please discuss any barriers to attending regular therapy with your psychologist as soon as difficulties arise.
Please note that if you arrive late to your therapy session, your session length will be reduced to ensure that the session is still completed in the scheduled time. For example, if you are 10 minutes late, your session will only be 40 minutes maximum. This is to ensure that appointments run to schedule and the following clients are not affected. We reserve the right to cancel the session and record it as a no-show if you are more than 30 minutes late without any communication with your psychologist. In this instance, the no-show cancellation fee will apply (full fee).
Fees must be paid prior to attending subsequent consultations. We reserve the right to cancel upcoming consultations if you have fees outstanding. We reserve the right to use debt collection services for failure to pay for services, including cancellation fees.
Referrals for diagnostic assessments and reports require payment up front for two (sometimes three) separate stages. This is because your psychologist invests considerable time reviewing the referral, liaising with relevant health professionals, collating pre-assessment results, and individualising the diagnostic and report preparation processes for each client.
If payment is covered by a third party payer, you will be required to pay up front and organise a reimbursement from your funding body after the session. Neurokin Psychology does not bill third parties directly for any consultations.
The first payment is required at the time of booking the Assessment Interview with your psychologist. This fee is 50% of your total payment. You will also be required to complete the New Client Intake and Consent forms online at the time of booking to ensure your appointment is reserved.
The balance must be paid at least two business days before the Feedback session. During the Feedback session, your psychologist will discuss the results of your assessment and the draft report. You will have the opportunity to ask questions and clarify any misinformation, prior the report being finalised and released to you.
Assessment package fees are set at:
Autism diagnosis: $2200
Autism and ADHD diagnoses: $2700
Other psychology assessments and reports are quoted at $250 / hr (and may incur an additional GST item).
Cancellation fees for assessment sessions are as follows:
More than 48 hours (2 business days) notice - Refund may be available**
Between 0 and 48 hours (1-2 business days) notice - 100% of consultation fee**
** For assessment clients, your psychologist will already have dedicated a number of hours towards collating background information for your referral, sending assessment questionnaires and reviewing initial data. A refund may be provided minus fees for hours already worked and materials used.
Please note any changes to Monday appointments must be confirmed by Thursday of the previous week (i.e. 2 business days), and changes to Tuesday appointments must be confirmed by Friday of the previous week. Weekends and public holidays do not count as business days.
Using our secure payment system, late cancellation penalties will be automatically processed. Your psychologist will have reserved this time for you, and it can be difficult to organise a new client to fill the spot with minimal notice. You may then reschedule the appointment. We reserve the right to cancel upcoming consultations and with hold your assessment results/report if you have cancellation fees outstanding.
We reserve the right to use debt collection services for failure to pay for services, including for cancellation fees.
Fees may be subject to change depending on the most appropriate and ethical assessment plan for your needs. If you book in for an ADHD-only, or Autism-only, assessment process, but your psychologist determines (based on pre-assessment questionnaires and/or indicators identified during your Assessment Interview) that you are likely to benefit from a more in-depth exploration of both ADHD and Autism, you will be encouraged to book an additional assessment session (usually 1-2 hours). The fee will be upgraded to align with the dual diagnosis rate, and the difference must be paid before attending the additional assessment session.
Occasionally, Neurokin Psychology psychologists will determine that an individual’s neurodivergence, medical, and/or psychiatric profile may present greater complexity for the diagnostic process than accounted for within the pre-set fees listed above. If the scope of your referral exceeds the allowances covered in the pre-set rates, you will be provided with an updated written, customised quote for you to consider before progressing with your assessment and diagnostic service. You may also be invoiced for additional preparation time if you submit extensive background documentation to be reviewed in the context of your diagnostic service at the standard rate ($250 /hr). You have the right to say no (in writing), although there will may still be a fee owing for work already undertaken to service your referral by that stage.
Assessment fees for adults are generally ineligible for Medicare rebates. However, people who are between 18 and 25 years old and referred by a paediatrician or psychiatrist as part of a Diagnosis and/or Treatment Plan for Complex Neurodevelopmental Disorders (including Autism) may be eligible for rebates. Please let us know if you have a referral for this at the time of booking.
Neurokin Psychology is NOT an emergency service. We are not able to respond to urgent or emergency matters and our communication channels Email is not monitored outside of standard business hours.
In case of emergency, please go to the emergency department of the nearest hospital or call 000.
Telehealth Psychology Services
Neurokin Psychology offers telehealth sessions delivered via videoconferencing software. Psychologists providing telehealth services apply the same ethical and professional standards of care and practice that are required when providing in-person psychology services. To participate in a telehealth service, clients will need to ensure they can log on the platform from a safe, private, comfortable environment. It is important that the person is free from distractions including children and pets. The psychologist must have emergency contact details for each client and be aware of the client’s physical location (address) at the time of the session.
Your psychologist may ask for your consent to record a telehealth session so that the audio (conversation) can be transcribed into a written summary for the purposes of facilitating the analysis of qualitative information and subsequent diagnostic evaluation(s). If you consent, your psychologist will enable Live Transcription via the Krisp App. You can request a copy of the transcription. The transcription will be stored within your secure client file, and will not be saved to any cloud storage platforms in order to preserve privacy and confidentiality. You will be informed before a recording takes place and can refuse to be recorded for any reason.
Potential benefits of telehealth consultations:
Improve access to services
Reduce your need for travel
Decrease exposure to infectious disease
Potential risks of telehealth consultations:
Be negatively impacted by technical problems, such as delays due to technology failures.
Not offer the same visual and sound quality for observations and modelling
Require you to have a support person available to assist
Increased exposure to privacy and digital security risks. To help with this, the practitioner must maintain confidentiality and privacy standards during sessions, and in creating, keeping and transmitting records.
While the practitioner is obligated to meet standards to protect your privacy and security, telecommunication, including videoconference, may increase exposure to hacking and other online risks; as with all online activities, there is no guarantee of complete privacy and security protection. You may decrease the risk by using a secure internet connection, meeting with the practitioner from a private location, and only communicating using secure channels.
Court / Tribunal / Mediation / Advice Policy
Neurokin Psychology does not provide any court reports/letters nor any legal advice regarding any legal matters. This includes Family Court matters regarding custody and parenting arrangements. Neurokin Psychology does not provide competency assessments, or fitness for work assessments. Neurokin Psychology does not provide assessments or reports for medico-legal purposes.